Forced Use as a Potential Cause of Gastrocnemius Tears During Neurologic Rehabilitation: A Report of 2 Cases

Steve R. Fisher, Laura L. Wiggs, Cindy B. Ivanhoe

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Fisher SR, Wiggs LL, Ivanhoe CB. Forced use as a potential cause of gastrocnemius tears during neurologic rehabilitation: a report of 2 cases. Broadly defined, forced-use therapy uses specific techniques designed to engage the patient with brain injury in activities that disallow overcompensation with the noninvolved or less involved body segments while forcing the use of the more involved segments. Some applications may involve placing the patient's hemiparetic extremity in a closed-chain weight-bearing activity with therapist support. We describe 2 cases of gastrocnemius muscle tears that occurred during inpatient neurologic rehabilitation that may be attributed to forced use of the hemiplegic lower extremity. Each presented with signs and symptoms indicative of deep vein thrombosis of the calf but was later confirmed with magnetic resonance imaging to be muscle tears. Some closed-chain, forced-use activities may be ill advised in the early stages of rehabilitation or if force generation of the muscle is inadequate to provide a protective response to overstretching. Gastroc-soleus tears should also be considered in the differential diagnosis of unilateral or even bilateral lower-extremity swelling and pain in neurologically impaired patients who are undergoing forced-use therapy.

Original languageEnglish (US)
Pages (from-to)386-388
Number of pages3
JournalArchives of Physical Medicine and Rehabilitation
Issue number3
StatePublished - Mar 2007
Externally publishedYes


  • Case report
  • Leg
  • Muscles
  • Rehabilitation
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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